| NPI | 1518992361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA DNF000337) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: GA DNCS000489) |
| 1223G0001X Dentist, General Practice (Licence: SC 2252) | |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2022-10-18 |